Lehner‐Dua 2001

Methods	Design: Randomised controlled trial
Participants	Participants: 48 parents from families with children aged 6‐11 years, recently diagnosed with ADHD by a mental health professional according to DSM‐IV criteria. Age: 6‐10 years (median age = 8). Gender: 33 boys, 15 girls. Number: 48. Setting: Hofstra University's Centre for Psychological Evaluation, Research and Counselling Clinic, New York, USA. Inclusion criteria: Children aged 6‐11 years, recently diagnosed with ADHD by a mental health professional according to DSM‐IV criteria.
Interventions	Parent Training Groups: Based on the "Defiant Children" programme developed by Barkley (Barkley 1997). 10 x 2 hour structured sessions of parent training on a weekly basis for 9 weeks with a booster session 1 month after the 9th session. At each session new concepts and skills were introduced, parent handouts were reviewed, new parent behaviours were modelled, parents rehearsed new skills and the homework assignment was reviewed. week 1: why children misbehave, week 2: pay attention, week 3: increasing compliance and independent play, week 4: when praise is not enough, poker chips and points, week 5: time out! and other disciplinary methods, week 6: extending time out to other misbehaviors, week 7: anticipating problems, managing children in public places, week 8: improving school performance from home, the daily school behaviour report card, week 9: handling future behaviour problems, week 10: booster session and follow up meetings. Control Groups: Parental discussion support group. This group met for 9 weekly 2 hour sessions and one follow‐up session 1 month later. There was no structured programme, parents discussed any problems raised by group members, there were no handouts and no homework assignments. After data collection parents were debriefed, given a summary of the results and any questions were answered.
Outcomes	Primary outcomes: Parents perceived severity of child's ADHD symptoms: Behaviour Assessment System for Children (BASC) (Reynolds 1998). Secondary outcomes: Change in parenting skills Parenting Sense of Competence (PSOC) (Johnston 1989). Parental level of stress Parent Stress Index (PSI) (Abidin 1986) (both as subscales, Child and Parent Domains) Outcomes not used in this review Total scores on the PSI were not used in this review as they were simple totals of the CD and PD domains of the PSI used elsewhere in meta‐analysis; Life Stress is not used.
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "In order to divide the participants into two groups, each participant chose a group time that was convenient for them. The groups were then randomly assigned a letter either A or B. The participants in A were the experimental group (parent training programme) and the participants in B were the control group (parent support). There were two groups of each in order to keep the group sizes to a workable number and provide greater availability for participants" (p 42).
Allocation concealment (selection bias)	Unclear risk	Precise method not stated.
Blinding (performance bias and detection bias) of participants?	High risk	Participants cannot be blinded to intervention.
Blinding (performance bias and detection bias) of those delivering intervention?	High risk	Those delivering intervention cannot be blinded ‐ least of all in these conditions: "the same experimenter ran both the parent training and support groups." (p 83).
Blinding (performance bias and detection bias) of outcome assessors?	High risk	Blinding of outcome assessors not mentioned and highly unlikely ‐ it would seem the investigator conducted her own assessments as well as having run both the structured treatment and the parent support group
Incomplete outcome data (attrition bias) All outcomes	High risk	Initially 80 calls from parents, 68 accepted to begin programme, 61 parents began the study, 48 parents completed the programme. (Barkley group began with 27 participants, 23 completed; Support group started with 34 participants, 25 completed). Drop out reasons given as shifting work schedules, family crisis and non‐applicability of groups. Dropouts uneven between groups.
Selective reporting (reporting bias)	Unclear risk	No obvious selective reporting but in the absence of a study protocol we cannot be clear.
Other bias	High risk	Investigator criticised her own design as follows: "A no contact group may be integrated in future research to be sure that the results were not due to just attention and/or contact with the participants ‐ statistically significant improvements in both the parent training and support groups for parents' sense of competence" (p 83) "The same experimenter ran both the parent training and support groups." (p 83) Large risk of contamination. "One parent in the support group had a friend in the parent training group which whom she compared notes." (p83). Investigator considers adding a confidentiality clause in future experiments.